Clinical course of covid-19 infection in children and adolescents

Clinical course of covid-19 infection in children and adolescents Olena V. Bolshova State Institution «V. P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine», Vyshgorodska Str., 69, Kyiv 04114, Ukraine The review highlights key findings on the clinical course of COVID-19 infection in children and adolescents. According to WHO, children under 18 years of age accounted for approximately 8.5% of reported cases. A significant percentage of children have asymptomatic or presymptomatic disease, with the potential to develop serious complications, including multisystem inflammatory syndrome (MIS-C), acute respiratory distress syndrome (ARDS), and prolonged COVID syndrome. The higher incidence of COVID-19 in children aged 5–15 years has been observed. Compared with adults, hospitalization and mortality rates in children with acute COVID-19 are quite low. Mild infection occurs in 36-40% of children (symptoms of acute upper respiratory tract infection such as fever, fatigue, myalgia, cough, sore throat, runny nose, and sneezing; some children may have only gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain). Moderate infection (signs of viral bronchitis and pneumonia such as fever, productive cough, rales, or moist sputum without tachypnea or hypoxemia) occurs in 46-50% of children. Child age (<1 year), chronic lung disease, type 1 diabetes, obesity, preterm birth, heart disease, and immunosuppressive status, vitamin D deficiency increase the likelihood of severe COVID in children. MIS-C features include systemic malaise, fever, hypotension, and cardiac dysfunction. Most patients with MIS-C were school-aged or adolescents aged 5–13 years.MIS-C involves at least four systems of the child, including cardiovascular changes (hypotension, myocardial dysfunction, pericarditis, coronary artery dilation or aneurysm, myocarditis, etc.), mucocutaneous (skin rash, conjunctival injection), respiratory (pneumonia, ARDS, pleural effusion, etc.), and gastrointestinal (pain in the animal, vomiting, or diarrhea). Neurological (headache, meningism, encephalopathy, etc.), nephrological (renal failure), and hepatological (hepatitis or hepatomegaly) symptoms are also observed. Even mild/asymptomatic SARS-CoV-2 infection can cause long-term symptoms that profoundly impact daily life in 8-10% of children.